CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 48.000000 3600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 65.500000 4912.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 18 34.500000 2587.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 55.500000 3080.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.500000 1387.5000 75.0000
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 5.000000 257.0500 51.4100
Subtotal (Total Children Is Unduplicated) 95 230.500000 16019.0500 69.4970
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 629 3783.000000 189052.0000 49.9741
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 37 76.000000 3800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 124.000000 8923.0400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 31 222.000000 15975.1200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 359.8000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 187.000000 13456.5200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 68.000000 4893.2800 71.9600
Subtotal (Total Children Is Unduplicated) 680 4465.000000 236459.7600 52.9585
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Total 4695.500000 252478.8100 53.7704
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Number of Children (Unduplicated) With at Least One Service 744
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 6 16.000000 909.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1301 4542.500000 242317.7600 0.0000
Other 71 137.000000 9251.2500 0.0000
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Total 1378 4695.500000 252478.8100 0.0000